Federal health fraud recoveries for FY 2017 totaled $2.6 billion, according to the latest HCFAC program annual report, compared to $3.3 billion in FY 2016. The Department of Justice (DOJ) opened 967 new criminal health care fraud investigations in FY 2017, filed criminal charges in 439 cases involving 720 defendants, obtained convictions of 639 defendants for health care fraud-related crimes, and opened 948 new civil health care fraud investigations. Furthermore, HHS Office of Inspector General (OIG) investigations resulted in 788 criminal actions and 818 civil actions related to Medicare and Medicaid, along with the exclusion of 3,244 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs.
The OIG identifies the following priority areas for HCFAC funding: protecting beneficiaries from prescription drug abuse; enhancing program integrity in non-institutional care settings (e.g., home health and hospice); improving oversight of the MA program; and strengthening Medicaid program integrity. The HCFAC report also observes that health care fraud investigations are considered a high priority within the Federal Bureau of Investigations (FBI) Complex Financial Crime Program, with each FBI field office having personnel assigned specifically to investigate health care fraud matters.